Aug. 30, 2013 - 06:03PM
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Headaches continue for physicians and military health care beneficiaries in the Tricare West Region as contract manager UnitedHealthcare Military & Veterans struggles to meet the demands of its Defense Department commitments.

Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson met Thursday with UnitedHealth Group CEO Stephen Hemsley. While the reason for the meeting was not disclosed, the subsidiary responsible for the $21 billion Tricare West Region contract continues to have ongoing problems such as stalled payments to providers, delayed referrals and backlogged claims.

Woodson was in Colorado Springs, Colo., on Wednesday, listening to the concerns of doctors, medical managers and Tricare beneficiaries over the challenges of working with the company, which assumed management of the 21-state regional contract on April 1.

Rep. Doug Lamborn, R-Colo., had invited Woodson to his district to understand the scope of the issues facing businesses and Tricare patients.

“A lot of providers are having trouble getting paid and navigating through the cumbersome claims process, and beneficiaries are having trouble getting treated,” said Lamborn, adding that he hears from providers and beneficiaries “all the time.”

UnitedHealthcare Military & Veterans was awarded the Tricare West region contract, which serves 2.9 million beneficiaries and is worth up to $21 billion over the next five years, in March 2012, and assumed management April 1, 2013.

Nearly immediately, Tricare customers in the region began experiencing delays in customer service and authorizations for referrals — problems so pervasive that Woodson on May 2 took the unprecedented step of waiving the requirement for Tricare Prime beneficiaries to obtain authorization first or face a penalty fee.

The waivers were extended multiple times and ended July 2. Tricare officials said United Healthcare had largely cleared the backlog of referral authorizations and was showing “real measurable progress in many aspects of contract compliance.”

But many of the same problems appear to be continuing. According to Jeff Anderson, practice manager for the Colorado Dermatology Institute in Colorado Springs, his clinic has seen a 33 percent drop in referrals because of processing problems at UnitedHealth Care Military & Veterans.

The company also issues authorizations that do not allow doctors to provide adequate health care for patients and is not allowing enough time to treat some conditions, resulting in patients needing to return to their primary care physicians for additional referrals and delaying care, Anderson said.

“Beneficiaries are waiting months to even get a referral and when they come in, they are coming through with only the most basic, most generic authorization for an office visit, not for any procedures. So if you have a lesion on your skin which may be cancerous, you are only authorized to come in to see us and you have to go back to Tricare for another referral. The physician is faced with a dilemma: either he or she tells you to go back and get that new referral or we treat and hope that Tricare will pay,” Anderson said.

Anderson’s practice also handles insurance claims for civilian patients who have other forms of UnitedHealth insurance, but it does not encounter the problems it sees with the subsidiary that serves Tricare, he added.

“United has not been successful in transitioning their vast amount of experience on the civilian side over to the very different military aspects of Tricare,” said Anderson, a retired Air Force lieutenant colonel.

The Defense Department released little information about either meeting, but Lamborn said the Pentagon is encouraging UnitedHealthCare Military & Veterans to automate its systems and streamline its processes.

“If they put in better processes and get their people better trained, they can handle the situation in a satisfactory way,” Lamborn said.

To help solve the problem, UnitedHealthcare hired additional personnel and authorized unlimited overtime. It also transferred the company CEO to another UnitedHealthCare subsidiary and installed Tina Jonas, a former Defense Department chief financial officer, as president of the company and hired Navy Vice Adm. John Mateczun, whose active-duty jobs included serving as Tricare’s first chief medical officer — a move likely to improve the company’s understanding of the military health system.

A company spokesman said Friday that UnitedHealthcare continues to make “real, measurable progress in many aspects of operations.”

“[We are] working collaboratively and effectively with the Department of Defense, the Tricare Management Activity, Tricare West Region office and military treatment facilities,” said vice president for communications Bruce Jasurda. “UnitedHealthcare is committed to ensuring TRICARE beneficiaries continue to receive timely and necessary access to care and the prompt payment of claims received.”

A Tricare official said in June that the Pentagon will not know for several months whether the ongoing problems have resulted in financial loss.

On Thursday, Pentagon spokeswoman Army Lt. Col. Cathy Wilkinson said Tricare officials are working with UnitedHealcare to ensure that service members, retirees and their families get timely, high quality medical care.

“Since the transition of the Tricare contract to UnitedHealth Care on April 1, 2013, our staff has been engaged in actively solving issues related to claims processing, provider payments, referral authorizations and network adequacy,” Wilkinson said.

Sen. Patty Murray, D-Wash., leader of the Senate Budget Committee, already has asked the Government Accountability Office to review the April 1 contract transition between previous contractor TriWest Healthcare Alliance to United Healthcare Military & Veterans.

Lamborn added that he hopes the issues will be solved by Sept. 30.

“They knew a year ahead of time they’d been getting the new contract, and it’s been over five months and things are still not in order. Things are still unacceptable,” Lamborn said.